Manager, Svcs Coord Advocate

3 weeks ago

Houston, United States Harris Health System Full time

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

- Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
- Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
- Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
- Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

**Skills / Requirements**:
**JOB SUMMARY**

The Manager, Service Coordination Advocate at Community Health Choice is a highly motivated and experienced manager with contact center experience. This role oversees the STAR+PLUS program and leads a team of Service Coordination Advocates.

The Manager plays a pivotal role in coordinating the administrative functions of the care management assistant team, ensuring the smooth operation of client care processes and the efficient delivery of services. Responsibilities include providing direction and support to the assistants, facilitating effective communication within the team and with other departments, and implementing strategies to enhance productivity and quality of care. The Manager collaborates with senior management to develop and implement policies, procedures, and initiatives aimed at improving client outcomes and operational efficiency.

**JOB SPECIFICATIONS AND CORE COMPETENCIES**
- Staff Management and STAR+PLUS Service Coordination:

- Manage staff handling STAR+PLUS Service Coordination Hotline calls, supporting members and providers with initial assessments, scheduling and rescheduling, HRA's, requests for Service Coordinators, and other benefits inquiries and authorization status updates.
- LTSS Knowledge and Care Management System:

- Maintain a working knowledge of LTSS, waivers, Community First Choice (CFC) services, and accurately enter required information into the designated care management system (OICS), adhering to departmental and organizational policies and procedures.
- Complex Member and Provider Concerns:

- Utilize critical thinking skills to resolve complex member and provider concerns.
- Professional Behavior and Interpersonal Skills:

- Maintain a professional behavior and exhibit excellent interpersonal skills.
- Collaborative Work:

- Work collaboratively with coworkers and the Medical Affairs Team to deliver member/provider services that meet or exceed expectations.
- Perform other duties as assigned.

**QUALIFICATIONS**:

- Education/Specialized Training/Licensure: Bachelors Degree or 4 years of experience in lieu of degree required.
- Work Experience (Years and Area): 5 years of related experience with Bachelors Degree. 9 years of experience in lieu of degree.
- Cross-functionality in claims, authorizations, benefits, and eligibility.
- STAR+PLUS Experience and understanding LTSS, Waivers, and Community First Choice (CFC)
- Management Experience (Years and Area): Two (2) years of supervisor experience in health care/health plan, including call center experience.
- Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Other: Ability to work independently under mínimal direction.

Moderate to advanced computer knowledge required.

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